Stories By Date

Survival of the Fittest

With all of the misinformation, rumor and hype that have been bandied about in the health-care reform debate, it is unsurprising how confusion has stoked the fears of many. Angry constituents have descended upon town hall meetings where hostile crowds have fumed at lawmakers. And in the midst of the hullabaloo, meaningful dialogue has been sacrificed. Has a health care overhaul been flummoxed or will a wayward message finally gain converts?

Frankly, what is surfacing is a survival of the fittest mentality. One demographic, being pitted against another, risks any true reform of the system and compromises the pursuit of good health for all.

One group in particular, unconvinced that change will not be destabilizing, has been the senior citizen population. Whether cautiously reluctant or downright suspect, seniors, many of whom are satisfied with Medicare, do not want to be scapegoated in the process to redress health-care grievances. At the crux, is the perceived threat that health care will be rationed for the elderly at the expense of insuring younger, healthier Americans. Seniors are not "on the chopping block," but propaganda and rhetoric would have you believe their interests will be disposed of readily.

What is true, however, is that there is already rationing in the America health care system. Insurance companies are able to differentiate which treatments are covered versus those deemed unnecessary. We, in the public, find this mediation palatable, but we question whether the government will interfere arbitrarily in our medical affairs.

While proposals are on the table to trim hundreds of billions from the 10-year projected growth of Medicare, an already bloated system, care will not be siphoned from the elderly. Health insurance reform promises to make Medicare more efficient and thus more tenable by affecting insurance subsidies and reimbursement practices, but current proposals do not curtail benefits. Overall, a revamped health system will enable more coordinated care. Facts sometimes lost in the clamor. Alas, we would better serve our seniors by winning additional concessions from the pharmaceutical industry for 1) cheaper medications, and 2) a faster route for generics to reach the consumer market.

Fabled talk of government-sponsored euthanasia, coupled with the lingering unease about paying for long term care have exposed the sensitivities surrounding end-of life issues. Foremost, there is no provision in any committee bill that funds euthanasia, nor is there any mandate to discuss living wills, advance directives or hospice with your medical provider. Rather, there is funding provided for those patients who choose to broach the subject with their physicians.

Ultimately, a rational, perhaps heated discourse is needed to assuage fears, concerns and skepticism. Of course debate should not be stifled, but neither should hidden agendas thwart an honest appraisal of the problem and possible solutions. There is room at the table for all to prosper - we just need to level the living field.

Comments

Please report offensive comments below.

I read the artine and all the comments , and frankly i di not dind any illuminating. Maybe I have gained wisdom with age. I am close to 77 years ago.I have retired 17 tears ago from a succesfuk career under 6 Presidents in the Executive Branch of the Federal goverbment. Over a span of 30 years as a public servant i have come to appreciate the excellence of most so called "government bureaucrats."Some of those often maligned are world experts in their field. Sure there ar e like any organization , some very much dummies who get kicked upstairs regularly because the branch or division they work in wwanta to get rid of them and then kick themout and up to the senior level of the government. By en large, I would sa that the majority of the people i wencountered could make far more in wages not working in the government. Theyare try public servants, To reward their sacrifice, they also receive the best medical care money can buy .I have that asa retiree , that is medicare with supplemental Blie Cross Blue Shield -Federl Program. So the proposed allegedreforms will not affect me.. or any person working for yhe Federal government who pays the set premiumz s) . Congreesman and women and Senators have the same medical privileged program. o for the rest of the country, if I would be selfish I would say the ords of clark gable in "Gone with the Wind,: My "My dearç, I do not gice a d.."Yhe fights intown hall, etc. is fun to watch because it is a game that adult plu imitating the daysd they were in Kindergarten!

Thanks for the vociferous feedback. So, let's chat. Again, there is no funding for euthanasia in any committee bill, however, this buzz word has been hurled about to incite confusion and fear. As stated in the article above, neither is there funding which mandates patients discuss end-of-life options. Rather there is a proposal to fund end-of-life discussions between a patient and his/her medical provider if the patient desires it. Euthanasia is not on the table when physicians and patients have such discussions.

Both a physician and minister, I do not support euthanasia. End-of-life options refer to advance directives, livings wills and hospice care. As a physician I have seen families consumed with grief asked to decide whether to place their loved one on a respirator or worse whether to turn a respirator off and the weight of the choice has been too much to bear. A living will or advance directive gives the patient autonomy to make those decisions during healthier times.

I do not advocate placing our lives in the government's hands. Nor do I advocate placing my life in the hands of insurance bureaucrats. I find it cliche that we in the public are more trusting of insurance companies when they stand to gain so much. I believe both government and the private sector should be put to greater scrutiny.

The article was entitled "Survival of the Fittest" because this sentiment has crept up and reared its head in this debate. I do not agree with this philosophy because the "living field" is undeniably skewed to favor those who successfully "game" the system while some are clueless to the rules of the match. Education, hence is key. Being informed of the stakes is crucial. I am a huge proponent of self-efficacy. I am not looking to a knight in shining armor (also known as the Federal government) to hold my hand and tell the neighborhood bullies to play nicely. Rather, government should step in and in partnership with the private sector ensure the well-being and cohesiveness of the social fabric-- that is those who wish to excel and work hard to prosper, can. But right now, you can work hard and be self-reliant and still be unable to afford or receive quality medical care and it is time for this reality to be dismantled.

And yes, we are scapegoating one group at the expense of others. The us vs them mentality is alive and well and now we have pitted seniors against non-seniors.

By the way, scapegoat can be both a noun and a verb. I'm actually a big fan of grammar. See insert from dictionary.com scape·goat (skāp'gōt')
n.
One that is made to bear the blame of others.
Bible A live goat over whose head Aaron confessed all the sins of the children of Israel on the Day of Atonement. The goat, symbolically bearing their sins, was then sent into the wilderness.
tr.v. scape·goat·ed, scape·goat·ing, scape·goats
To make a scapegoat of.)

Let's make the argument relevant folks. Lives and livelihoods are on the line.

Thanks for the vociferous feedback. So, let's chat. Again, there is no funding for euthanasia in any committee bill, however, this buzz word has been hurled about to incite confusion and fear. As stated in the article above, neither is there funding which mandates patients discuss end-of-life options. Rather there is a proposal to fund end-of-life discussions between a patient and his/her medical provider if the patient desires it. Euthanasia is not on the table when physicians and patients have such discussions.

Both a physician and minister, I do not support euthanasia. End-of-life options refer to advance directives, livings wills and hospice care. As a physician I have seen families consumed with grief asked to decide whether to place their loved one on a respirator or worse whether to turn a respirator off and the weight of the choice has been too much to bear. A living will or advance directive gives the patient autonomy to make those decisions during healthier times.

I do not advocate placing our lives in the government's hands. Nor do I advocate placing my life in the hands of insurance bureaucrats. I find it cliche that we in the public are more trusting of insurance companies when they stand to gain so much. I believe both government and the private sector should be put to greater scrutiny.

The article was entitled "Survival of the Fittest" because this sentiment has crept up and reared its head in this debate. I do not agree with this philosophy because the "living field" is undeniably skewed to favor those who successfully "game" the system while some are clueless to the rules of the match. Education, hence is key. Being informed of the stakes is crucial. I am a huge proponent of self-efficacy. I am not looking to a knight in shining armor (also known as the Federal government) to hold my hand and tell the neighborhood bullies to play nicely. Rather, government should step in and in partnership with the private sector ensure the well-being and cohesiveness of the social fabric-- that is those who wish to excel and work hard to prosper, can. But right now, you can work hard and be self-reliant and still be unable to afford or receive quality medical care and it is time for this reality to be dismantled.

And yes, we are scapegoating one group at the expense of others. The us vs them mentality is alive and well and now we have pitted seniors against non-seniors.

By the way, scapegoat can be both a noun and a verb. I'm actually a big fan of grammar. See insert from dictionary.com scape·goat (skāp'gōt')
n.
One that is made to bear the blame of others.
Bible A live goat over whose head Aaron confessed all the sins of the children of Israel on the Day of Atonement. The goat, symbolically bearing their sins, was then sent into the wilderness.
tr.v. scape·goat·ed, scape·goat·ing, scape·goats
To make a scapegoat of.)

Let's make the argument relevant folks. Lives and livelihoods are on the line.

In the case of "Obamacare" it is the inherently inferior black man who is plotting to undermine them. He is lying to them because he intends to socialize them which means turn them into poor ignorant blacks, and take away their freedom ( whiteness and place of power) which is their natural right. Why else the screaming and weeping we have seen on tv? What are these people really afraid of if not the horrors in their own subconcious minds? One woman at a town hall who was particularly frantic kept saying "I am frightened of Obama". And she truly is, that is why we should be terrified of her.
As far a sincerety goes, there is no doubt that these people are sincere, the problem is that they are sincerely nuts and that their craziness can become extremely violent as their paranoia and delusions grow. We need to be on gaurd for the demogog slouchs to Washington to be born again.
++++++++++++++++++++++++++++++++++++++
As we have said so many times, it is the left in this country who are the true racists. Because a woman is frightened of Obama, then that means you should be frightened of her? Amazing.

Funding provided for euthanasia?!? Just how much funding are we talking here? Socialized health care is neither in the best interest of the American people or even remotely intelligent, let alone a solution for our health care fiasco.

Additionally: who edited (or rather failed to do so) this article? C'mon, Post. One more step towards lack of credibility...

Where does WRBurton get his misinformation? Here is the first sentence from Wikipedia's description of Taiwan's health insurance scheme. You can go there and read the rest.

"The current health care system in Taiwan, known as National Health Insurance (NHI), was instituted in 1995. NHI is a single-payer compulsory social insurance plan which centralizes the disbursement of health-care funds."

This is not a partisan debate - this is about the reality of life and death. If you trust the government with your life - then you will want this "reform". If you don't trust the governement - the same government that is squadering your tax dollars, bankrupted Social Security, and proposing $500Billion cuts in Medicare benefits - then you will be against this "reform". This has nothing to do with GOP or Dem.

you have all seen the republican comment, (we will not sign a bill unless it is private insurence companies only) No gov programs like medicare, whom has few complaints then private insurence, My 91 year old mother inlaw has any doctor ordered test paid no questions, SO MUCH FOR THE TO OLD LIE. This is about private insurence controling your health care, for profit, the more members your insurence loses, the more claims by you will be denied,Remember we must not fuss when this death panel looks at you. you scream at the town meeting, now you must harvest the seed you planted.

Sorry for inserting a mostly irrelevant comment, but I can't help responding to bjspanos' rather snooty grammar lesson.

bjspanos: While you were picking on Dr. Pernell for turning the noun "scapegoat" into the verb "scapegoated" you included two fragmentary sentences that are considered poor writing. Those two sentences are: 1) "Just a thought thrown into the mix" and 2) "My two cents for what it's worth."

If you're going to critique grammar perhaps you should take a good look at your own grammatical mistakes.

The British are TELLING US that their system, while not perfect, is a good one;
-------------------------------------------
I read the British press every day. Here's one thing the US press won't tell you: elderly British WWII veterans who risked their lives for their country, and who paid into their National Health Service for 50 years, are being left to starve and freeze to death, while newly come Muslim immigrants who paid nothing into the system are allowed to get healthcare benefits for their "extra" polygamous "wives." Google for the article entitled "Alfred Must Die so That Mahmoud Can Live" for the full details.

If there are so many billions and billions of dollars of "waste" in Medicare, then why doesn't the Administration and Congress cut out all the waste to begin with? Why do we need to create a whole new entitlement program in order to deal with this "waste."

Show us that you can responsibly manage our money, and then maybe we'll go for your vast new healthcare program. But right now the same people who gave us the "wasteful" Medicare are designing the new system. Why would we entrust these same people who designed the horribly "wasteful" Medicare system to come up with something better?

Please note that if you are over 65 you will have most likely paid into Medicare for 45 years. Yes, I think it is obscene that somebody who paid for something for 45 years is now being told they are having it taken away, especially when it will be taken away to provide healthcare for foreigners, both legal and illegal, who never paid a dime into the system, or only paid for a few years.

The distortions cited as fact are incredible - but so are the people writing these comments. Gee, we have social Darwinism now - the rich get health care\ the poor don't. The part that people cite about "end-of-life options" was put in by the GOP Senator from Georgia and of course is distorted. Those who don't want government in health care then go on to tell us how much government is in health care. One tirade on here confuses Medicare and Medicaid. But all those opponents say they know the truth but others don't. Since Medicare, the VA and Medicaid cost the Feds $1 trillion a-year in taxes, and then state and local government kick in hundreds of billions more - the financial quagmire is already there.

How many of these people have no problem that American tax payers pay more for defense than the next 10-nations combined.
That comes out of my pocket - and I don't like it. These people don't care about reform - they are just partisan lying hacks.

Perhaps the most frightening aspect of Nazi Germany was the mass delusion. The masses truly believed in the superiority of the Aryan race, their destiny to rule and their need to expand their empire into lands that had unfairly treated their own superior landsmen. I find this whole birther fantasy frightening for its disregard and even inablity to absorb and properly process reality. It is as if the facts are servants to their subconscious fears.

Beings of political correctness, the left and liberal media take pains not to point out the real irony, which is that blood purity and the endless investigation of birth records was the Nazi regime's basic m. o. The fear that the "other race", inherently inferior and disgusting, will control the lives of their own superior race was a prime motivation. And, as in the denial of the holocaust, logic is turned on its head - the victims are turned into the liers and persecutors.

In the case of "Obamacare" it is the inherently inferior black man who is plotting to undermine them. He is lying to them because he intends to socialize them which means turn them into poor ignorant blacks, and take away their freedom ( whiteness and place of power) which is their natural right. Why else the screaming and weeping we have seen on tv? What are these people really afraid of if not the horrors in their own subconcious minds? One woman at a town hall who was particularly frantic kept saying "I am frightened of Obama". And she truly is, that is why we should be terrified of her.

As far a sincerety goes, there is no doubt that these people are sincere, the problem is that they are sincerely nuts and that their craziness can become extremely violent as their paranoia and delusions grow. We need to be on gaurd for the demogog slouchs to Washington to be born again.

Greater government control of healthcare works in democratic countries all over the world. Europeans, Canadians and Australians enjoy longer lives and lower infant mortality rates. The facts are compiled by our CIA at these web links:

Misinformation about the European healthcare systems abound as well. But one indisputed fact is they pay much less than we do, in some cases half what Americans pay per capita. They cover all their citizens. And they're citizens are healthier.

So why the hysteria over greater government control? The government controls many areas of American life from education to emergency services. And we have not been taken over by Communists.

Is it not logical to learn from our friends and allies in modern democracies like ours? The solutions to our problems are right there. They are proven. We need only to adopt them.

The lack of information is coming from the proponents of health care reform who have yet to detail how they will pay for universal coverage. Most Americans are smart enough to suspect that higher taxes will be required or that the government will have to curb Medicare offerings; ie waste. Most Americans understand that expansion of health care will add to the federal budget deficit.

Health care reform should focus on market-based corrections that will NOT add to the budget deficit.

1) across-state health care plans that bypass state controls that increase costs
2) anti-trust exemptions for doctors to negotiate with hospitals
3) a program to pay the cost of the medical education of primary-care doctors in exchange for a set period of service in an urban or rural health care clinic
4) limits on mal-practice awards
5) creation of high-risk pool for individuals with pre-existing medical conditions. In the auto industry, high-risk drivers are covered by pool in which all insurance carriers contribute. Apply this concept to health care insurance.

If Obama and the liberal Democrats accept the fact that most Americans don't want mandates and don't want to pay the price at this time for universal coverage, then Congress can craft legislation to fix the current system of health care, which, although not perfect, serves the needs of most Americans.

It is interesting that this article is titled “Survival of the Fittest” because that is one of my greatest worries of the government gaining control of health care. It is opening the door to social Darwinism which has been advocated by progressives since Darwin came out with his theory. Our government is now full of progressives and even if their current policy proposals don’t have overt social Darwinism in them, it opens the door to social Darwinism in the future. Even some of the current policy proposals if enacted could be interpreted by a progressive judge to allow social Darwinism to occur in one form or another. It is one thing to have private companies rationing health care, but another to allow government to do it. Private companies can be regulated or face losing business to companies that don’t ration, but government can be much harder to control. The government is indoctrinating our children with Darwin’s theory with no counteracting moral values and I see this as a step towards making them accepting of future social Darwinist policies. Does anyone remember eugenics? Eugenics was a progressive government policy at one time and could return again in a different form if the government is given control of health care.

This comment isn't exactly on point, but as an educated woman, I feel Dr. Pernell or do you prefer Rev. Pernell should know better. "Scapegoated" is NOT a word. It is a noun being turned into a verb. Just a thought thrown into the mix. Maybe we can't change the tenor of the healthcare debate - not sure I want to as it is refreshing to see everyday Americans becoming passionate and engaged - but we can encourage the use of correct English in the process. My 2 cents for what it's worth.

you have all seen the republican comment, (we will not sign a bill unless it is private insurence companies only) No gov programs like medicare, whom has few complaints then private insurence, My 91 year old mother inlaw has any doctor ordered test paid no questions, SO MUCH FOR THE TO OLD LIE. This is about private insurence controling your health care, for profit, the more members your insurence loses, the more claims by you will be denied,Remember we must not fuss when this death panel looks at you. you scream at the town meeting, now you must harvest the seed you planted.

Canada was able to afford a universal health care system that worked well. Recently, problems have emerged because the Federal government decided to significantly reduce its contribution to funding the program (under our Constitution, health care is a provincial responsibility; since it doesn't require permission to move from one province to another, provinces are under strong pressure to keep taxes low).

All industrialized countries except the U.S. have universal health care, so it would seem strange to suggest that the U.S. can't afford it. But because there is always pressure to keep costs down for anything funded by taxes, without the U.S., there might be no honest standard of what a doctor's work is worth.

And the other danger is that medical research might languish if every new cure meant something extra the government had to pay for. So, although universal health care is a good thing, for the U.S. to take special care in implementing it is not unreasonable to ask.

The poster who wrote this is flat out mis-informed. This is NOWHERE mandated. I have been a critical care (ICU) RN for 35 years. We have had Advanced Directives in hospitals for at least 35 years. This is nothing new. And people who have absolutely NO knowledge on the healthcare system should keep their mouths shut until they know the facts. I have gone over "advanced directives" many times with patients and on admission to a hospital it was a part of our paperwork, and always has been. It has absolutely nothing to do with healthcare rationing or anything of the like. So you all shut your mouths and educate yourselves.

"While proposals are on the table to trim hundreds of billions from the 10-year projected growth of Medicare, an already bloated system, care will not be siphoned from the elderly."

And how does the author get off making a blanket statement such as "care will not be siphoned from the elderly"? Has she read the bill? I don't think so. Perhaps she has and couldn't understand it, but doesn't want to admit it.

Does she know who advises Obama on healthcare? Ezekiel Emanuel, brother of Rahm, who believes in basing care received on age and expected productivity. But don't quote me, take ten minutes and look at Glenn Beck's YouTube video on the issue: http://www.youtube.com/watch?v=HVGvAXaN7Fk

Ezekiel Emanuel's statements quoted by Mr. Beck were published this year, in January 2009. The life chart is shown in this video as well. Where are you on this life chart?

The more important question is this: If Obama does not subscribe to this sort of sick thinking, why be advised by a man who clearly does?

Calling those who oppose this alleged "healthcare reform" irrational or ignorant, or racist or any other sort of names as I've seen elsewhere, is only a shameless attempt to derail the discussion from the details in this bill.

And what's more telling of intent is what's been omitted from this bill, namely tort reform. Why isn't this addressed in this bill? Because, if this bill is passed, tort reform becomes a moot point. This bill is designed to end private insurance, to bring all healthcare professionals into the employ of the government and thus under the protective clause of the bill which does not allow any individual insured to sue for any sort of malpractice, such as a child dying while the government drags its feet in making a decision on what care to provide based on the child's age and expected years of productivity.

My child would be dead if this bill had been law in 1999 because she had to have surgery in the second month of life. My child's health now, and her expected productivity is the equal of that of any other child her age, but under Ezekiel Emanuel's life chart, if there'd been a shortage of available healthcare due to, say, a shortage of money to pay for healthcare, her surgery most likely would've been denied since she was but two months of age.

Read the bill. The concerns are very real. And every halfway-informed American should be terrified.

Don't get me wrong, I'm in favor of healthcare reform and fixing what's broken in our current system. But this bill is the antithesis of fixing what's broken--this bill is nothing less than an attempt to take control of our lives.

let take the post office its what 2.8 billion in the hole this year they had to close 700 post offices.they had to raise postage. in other words when the government runs a program like health care it will overspend the cost will skyrocket and it will raise taxes it will reduce staff and ration health care

When we have hard copy of the "proposals" in question, where is the confusion that you speak of, and where does the confusion come from?
When we read publicly, verbatim, from these "proposals", we are accused of anti Obama racist rhetoric... what is so racist about reading from a "bill" he has endorsed (but not read). Are their some in his clique who are sabotaging the "Government's" newest front man by writing racist material?

For the so called "Liberals" to demand that Americans keep there mouths shut, speaking only in whispers and then only to squeal to the "Government" if they hear something "fishy", is damning in the extreme.
To demand I and hundreds of millions of actual Americans suspend disbelief in/of our "Government" after multiple decades of two party shenanigans and proven lies, deceit and out right murder...
If I had an actual, Constitutionally mandated government, as oppose to this corporation foisted off on me by banksters and their fellow travelers, I might have reason to trust said "Government".
Then again, an actual Constitutional government wouldn't even be considering playing mommy and daddy to Sovereign American Citizens, natural born or otherwise.

In conclusion, I find the very fact that we are, and have been for some time, a socialist Country to be offensive. I support only those Americans who wish to be free people, non hyphenated and without divided loyalties.
Go your own way, if you wish to be enslaved.

Obviously this Ms Pernell has not read either the House or Senate Bill. First,
the elderly ARE on the chopping block.
This is not fear - this is fact. The House bill is proposing to cut $500 BILLION from Medicare and at the same time, ADD 30 Million patients to Medicare. To simplify this for MS Pernell - If you're used to sharing a 12 inch pizza with four others and then next week you are given an 8 inch pizza to share with 10 people - do you think you're going to get the same amount of pizza?
Another item the "left" is calling "fear" yet in the Bills as fact is "end of life counciling" This is a mandated requirement. Once you reach 65 years old you are required (not your choice) to meet with a government employee to talk about your end of life options.
Since when does the Government care about your end of life? Why would they care if they really cared about you and the healthcare you receive? The answer: Cost controls.
Obama recently compared healthcare reform with a government option to the Post Office and UPS/Fedex competition. He said, "UPS and Fedex are doing fine; competing with the Post Office, a government run organization". What Obama failed to recognize was the REASON UPS and Fedex exist today...they exist because the Post Office failed. This failure left an opening that the private sector filled. What Obama is proposing is the exact opposite. In fact, the current Senate Bill states that if there are any changes to your private plan (Benefits, beneficiary, etc) then you will have one year to change to a Government sanctioned plan!! What the hell? They are mandating, over time, the removal of private insurance options! I urge you ALL to get informed and READ THE BILLS!! This is not fear mongering, these things ARE in the current Bills. We have a Healthcare system that needs help but NOT at the expense of another government take-over.

in Oregon the state run health care has refused to give live extending medication. and instead offered assisted suicide, they are the same liberals that push for obama care. most of the obama plan comes from the state run plans because they don't have any original plans they copy ideas from placed like ma nj ny ca or ks all failed heath care systems that have broken the states budgets all cut, and rationed . the the person righting article this should say what a failure the NJ state run health care has been ask the sitting Governor who is about to lose his job in a landslide to a republican in a almost all democrat run state .

The assault against seniors began with the stimulus package in February. Slipped into the bill was substantial funding for comparative effectiveness research, which is generally code for limiting care based on the patient’s age. Economists are familiar with the formula, where the cost of a treatment is divided by the number of years (called QALYs, or quality-adjusted life years) that the patient is likely to benefit. In Britain, the formula leads to denying treatments for older patients who have fewer years to benefit from care than younger patients.

When comparative effectiveness research appeared in the stimulus bill, Rep. Charles Boustany Jr., (R., La.) a heart surgeon, warned that it would lead to “denying seniors and the disabled lifesaving care.” He and Sen. Jon Kyl (R., Ariz.) proposed amendments to no avail that would have barred the federal government from using the research to eliminate treatments for the elderly or deny care based on age.

From my experience in healthcare, since the inception of advance directives legislation; advance directives are activated in cases when patients of any [adult] age become incapable of making decisions. That is why the earlier you can do it, the better. Many younger people suffer severe head trauma from accidents and remain non-decisional permanently. A healthcare power of attorney type of advance directive lets an agent the person has chosen make the healthcare decisions the patient would want if he/she could speak for him/herself. That is why the person writing the advance directive should discuss the medical treatments they would like if they ever became nondecisional. You can even tell your agent, and write in your advance directive, that if you ever become nondecisional, you would like "everything done".

An advance directive only comes into play if you are incapable of making decisions. If you are able to express yourself in any way--eye blinking, hand-squeezing,--you are asked what medical treatment you would like. If you are non-decisional and your advance directive has been activated, and you become decisional again, the advance directive is deactivated and you are asked what medical treatments you want.

It's not perfect, but an advance directive does help health care professionals provide the treatment a non-decisional patient would like.

Calling people paranoid and irrational is hardly a way to get a meaningful dialogue started.... If the President were to be honest, he might admit that his initial strategy was to work toward a single payer system by incrementally introducing a government option. Instead he denies the obvious. How can a "rational" person trust him? Throughout the world there are many variations of health care systems, including the very successful Taiwan system which does NOT have a government insurance plan but DOES have universal health care at HALF the cost compared to their GDP. Democrats have no one to blame but themeselves. Trying to arrogantly ram down the throats of all Americans their radical and ideologically driven views will send them back to minority status very quickly. Let's put ALL our heads together an develop a BI-PARTISAN approach based on efficiency and effectiveness, not ideology from the left or the right.

Many or us don't trust politicians to make good decisions for us, only for themselves. We have an Independent Blue Ribbon Commission discussing the future of NASA. Why not one for health care/insurance reform? What would be the objection of Obama and the Democrats from asking for a commission? The fact that they won't establish a commission and are not letting other proposals to be considered makes me believe the 1000 page House bill is an attempt to take over 1/6 of the economy by the president and his allies to enchance their political power.

The Government has no business being in any business let alone the health care business. My health is my responsibility and my health decisions are between my doctor and me - not government bureaucrats. This legislation sets up a whole new vast bureacracy designed to interfere in life or death decisions based on economic analyses of an individual's life's worth. No thanks. Those who choose to believe the Obama hype instead of reading the legislation are doing this country a vast disservice. And they will be the first to bitterly complain when things don't go their way.

"While proposals are on the table to trim hundreds of billions from the 10-year projected growth of Medicare, an already bloated system, care will not be siphoned from the elderly."

This is a large part of the concern. Many doctors are currently refusing to take more medicare patients due to dropping fees. Yet the government claims that hundreds of billions will be cut. It has not been explained "how".

I have no ax to grind. I'm waiting to see what comes "out the other end" before I dive into the debate. However, it is unclear exactly what we're trying to accomplish. Are we trying to get coverage for everyone? Are we trying to get rid of employer coverage, and move to something more univeral?

My suggestion:

1. A very simple statement of principles and goals to define what it is we're attempting to do.

2. A very simple statement of the mechanism we're going to use to attain each of the goals.

3. A very simple explanation on how we're going to pay for each of those mechanisms.

With the above, we can then have a true debate. Right now, everything is so vague that you're going to have strife and conflict due to fear of the unknown.

Our Nat'l Debt is 11 Trillion, our deficit is 1.5 Trillion. Medicare, Medicaid, Soc Sec, and Rx Drug Prog have unfunded liabilities of 68 Trillion. How do we add Obamacare (GAO says 1.5 T and they're being nice!!!) on top of that? You could tax the rich 100% and cut Medicare 100% and STILL not be able to pay for it. Please stop with the lies. It's really disgusting.

How can one have a rational conversation with irrational people? Some of the conspiracy theories and rhetoric for those against healthcare reform sound like the imagings of a science fiction writer. Change is always difficult, but that does not mean it should not happen. It will be a very sad and detracting day when America sees no change in healthcare, education or anything that comes up because a bunch of backwoods, small minded people are scared of everything that doesn't look like, sound like or act like what they have seen or known for the past 100 years even when what they are used to DOES NOT WORK for them or anyone else.

What's in the reform needs to be completely laid open, honestly and come to a bigger audience for vote, because I am not one who wants to wake up to outdated systems that fail the majority of their citizens for the next year much less 20, 30 or more years because these people go on and off of insane, emotionally charged, nonsensical rhetoric based off greedy leaders that have them brainwashed with false ideals and no good ideas of their own.

The British are TELLING US that their system, while not perfect, is a good one; but the health reform critics (read: Republicans and other paranoid Americans) won't listen because it doesn't support their argument.

What is the matter with them? Have they become so party-fanatical that reason, common sense and FIRSTHAND KNOWLEDGE become irrelevant? Having only ever existed in a for-profit health care system, they CANNOT KNOW what it is to have existed in a universal one. Yet they behave as if they do and that all a Democrat-controlled government can do is sinister and not to be trusted.

A British NHS spokesman--with support from those singled out by critics--is DEBUNKING these untruths, but nobody listens.